H360 Exam 4 Questions with complete
solution 2025/2026
A patient became severely depressed when the last of six children moved out of the home 4 months
ago. The patient repeatedly says, No one cares about me. Im not worth anything. Which response by the
nurse would be the most helpful?
a. Things will look brighter soon. Everyone feels down once in a while.
b. The staff here cares about you and wants to try to help you get better.
c. It is difficult for others to care about you when you repeatedly say negative things about yourself.
d. Ill sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this
afternoon. - correct answer ✔D (I'll sit with you for 10 minutes now and return for 10 minutes at
lunchtime and again at 2:30 this afternoon.
Spending time with the patient at intervals throughout the day shows acceptance by the nurse and
helps the patient establish a relationship with the nurse. The therapeutic technique is called offering
self. Setting definite times for the therapeutic contacts and keeping the appointments show
predictability on the part of the nurse, an element that fosters the building of trust. The incorrect
responses would be difficult for a person with profound depression to believe, provide trite reassurance,
and are counterproductive. The patient is unable to say positive things at this point.)
A patient became depressed after the last of six children moved out of the home 4 months ago. The
patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, No one cares about me
anymore. Im not worth anything. Select an appropriate initial outcome for the nursing diagnosis:
Situational low self-esteem, related to feelings of abandonment. The patient will:
a. verbalize realistic positive characteristics about self by (date) .
b. consent to take antidepressant medication regularly by (date) .
c. initiate social interaction with another person daily by (date) .
d. identify two personal behaviors that alienate others by (date) . - correct answer ✔A (verbalize
realistic positive characteristics about self by (date) .
,Low self-esteem is reflected by making consistently negative statements about self and self-worth.
Replacing negative cognitions with more realistic appraisals of self is an appropriate intermediate
outcome. The incorrect options are not as clearly related to the nursing diagnosis. Outcomes are best
when framed positively; identifying two personal behaviors that might alienate others is a negative
concept.)
A nurse wants to reinforce positive self-esteem for a patient diagnosed with major depressive disorder.
Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate?
a. You look nice this morning.
b. You are wearing a new shirt.
c. I like the shirt youre wearing.
d. You must be feeling better today. - correct answer ✔B (You are wearing a new shirt.
Patients with depression usually see the negative side of things. The meaning of compliments may be
altered to I didn't look nice yesterday or They didn't like my other shirt. Neutral comments such as an
observation avoid negative interpretations. Saying You look nice or I like your shirt gives approval
(nontherapeutic techniques). Saying You must be feeling better today is an assumption, which is
nontherapeutic.)
An adult diagnosed with major depressive disorder was treated with medication and cognitive
behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which
intervention should the nurse suggest?
a. Social skills training
b. Relaxation training classes
c. Use of complementary therapy
d. Learning desensitization techniques - correct answer ✔A (Social skills training
Social skills training is helpful in treating and preventing the recurrence of depression. Training focuses
on assertiveness and coping skills that lead to positive reinforcement from others and the development
of a patients support system. The use of complementary therapy refers to adjunctive therapies such as
,herbals. Assertiveness would be of greater value than relaxation training because passivity is a concern.
Desensitization is used in the treatment of phobias.)
A priority nursing intervention for a patient diagnosed with major depressive disorder is:
a. distracting the patient from self-absorption.
b. carefully and inconspicuously observing the patient around the clock.
c. allowing the patient to spend long periods alone in self-reflection.
d. offering opportunities for the patient to assume a leadership role in the therapeutic milieu. - correct
answer ✔B (carefully and inconspicuously observing the patient around the clock.
Approximately two thirds of people with depression contemplate suicide. Patients with depression who
exhibit feelings of worthlessness are at higher risk. Regularly planned observations of the patient with
depression may prevent a suicide attempt on the unit.)
When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will
address the negative thought patterns by using:
a. psychoanalytic therapy.
b. desensitization therapy.
c. cognitive behavioral therapy.
d. alternative and complementary therapies. - correct answer ✔C (Cognitive behavioral therapy.
Cognitive behavioral therapy attempts to alter the patients dysfunctional beliefs by focusing on positive
outcomes rather than negative attributions. The patient is also taught the connection between thoughts
and resultant feelings. Research shows that cognitive behavioral therapy involves the formation of new
connections among nerve cells in the brain and that it is at least as effective as medication. Evidence
does not support superior outcomes for the other psychotherapeutic modalities mentioned.)
A patient says to the nurse, My life does not have any happiness in it anymore. I once enjoyed holidays,
but now theyre just another day. How would the nurse document the complaint?
, a. Vegetative symptom
b. Anhedonia
c. Euphoria
d. Anergia - correct answer ✔B (Anhedonia
Anhedonia is a common finding in many types of depression and refers to feelings of a loss of pleasure
in formerly pleasurable activities. Vegetative symptoms refer to somatic changes associated with
depression. Euphoria refers to an elated mood. Anergia means without energy.)
A patient diagnosed with major depressive disorder is taking a tricyclic antidepressant. The patient says,
I dont think I can keep taking these pills. They make me so dizzy, especially when I stand up. The nurse
should:
a. explain how to manage postural hypotension, and educate the patient that side effects go away after
several weeks.
b. tell the patient that the side effects are a minor inconvenience compared with the feelings of
depression.
c. withhold the drug, force oral fluids, and notify the health care provider to examine the patient.
d. teach the patient how to use pursed-lip breathing. - correct answer ✔A (explain how to manage
postural hypotension, and educate the patient that side effects go away after several weeks.
Drowsiness, dizziness, and postural hypotension usually subside after the first few weeks of therapy with
tricyclic antidepressants. Postural hypotension can be managed by teaching the patient to stay well
hydrated and rise slowly. Knowing these facts may be enough to convince the patient to remain
medication compliant. The minor inconvenience of side effects as compared with feelings of depression
is a convincing reason to remain on the medication. Withholding the drug, forcing oral fluids, and having
the health care provider examine the patient are unnecessary steps. Independent nursing action is
appropriate. Pursed-lip breathing is irrelevant.)
A patient diagnosed with major depressive disorder is receiving imipramine (Tofranil) 200 mg every
night at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care
provider regarding potentially hazardous side effects of this drug?
solution 2025/2026
A patient became severely depressed when the last of six children moved out of the home 4 months
ago. The patient repeatedly says, No one cares about me. Im not worth anything. Which response by the
nurse would be the most helpful?
a. Things will look brighter soon. Everyone feels down once in a while.
b. The staff here cares about you and wants to try to help you get better.
c. It is difficult for others to care about you when you repeatedly say negative things about yourself.
d. Ill sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this
afternoon. - correct answer ✔D (I'll sit with you for 10 minutes now and return for 10 minutes at
lunchtime and again at 2:30 this afternoon.
Spending time with the patient at intervals throughout the day shows acceptance by the nurse and
helps the patient establish a relationship with the nurse. The therapeutic technique is called offering
self. Setting definite times for the therapeutic contacts and keeping the appointments show
predictability on the part of the nurse, an element that fosters the building of trust. The incorrect
responses would be difficult for a person with profound depression to believe, provide trite reassurance,
and are counterproductive. The patient is unable to say positive things at this point.)
A patient became depressed after the last of six children moved out of the home 4 months ago. The
patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, No one cares about me
anymore. Im not worth anything. Select an appropriate initial outcome for the nursing diagnosis:
Situational low self-esteem, related to feelings of abandonment. The patient will:
a. verbalize realistic positive characteristics about self by (date) .
b. consent to take antidepressant medication regularly by (date) .
c. initiate social interaction with another person daily by (date) .
d. identify two personal behaviors that alienate others by (date) . - correct answer ✔A (verbalize
realistic positive characteristics about self by (date) .
,Low self-esteem is reflected by making consistently negative statements about self and self-worth.
Replacing negative cognitions with more realistic appraisals of self is an appropriate intermediate
outcome. The incorrect options are not as clearly related to the nursing diagnosis. Outcomes are best
when framed positively; identifying two personal behaviors that might alienate others is a negative
concept.)
A nurse wants to reinforce positive self-esteem for a patient diagnosed with major depressive disorder.
Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate?
a. You look nice this morning.
b. You are wearing a new shirt.
c. I like the shirt youre wearing.
d. You must be feeling better today. - correct answer ✔B (You are wearing a new shirt.
Patients with depression usually see the negative side of things. The meaning of compliments may be
altered to I didn't look nice yesterday or They didn't like my other shirt. Neutral comments such as an
observation avoid negative interpretations. Saying You look nice or I like your shirt gives approval
(nontherapeutic techniques). Saying You must be feeling better today is an assumption, which is
nontherapeutic.)
An adult diagnosed with major depressive disorder was treated with medication and cognitive
behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which
intervention should the nurse suggest?
a. Social skills training
b. Relaxation training classes
c. Use of complementary therapy
d. Learning desensitization techniques - correct answer ✔A (Social skills training
Social skills training is helpful in treating and preventing the recurrence of depression. Training focuses
on assertiveness and coping skills that lead to positive reinforcement from others and the development
of a patients support system. The use of complementary therapy refers to adjunctive therapies such as
,herbals. Assertiveness would be of greater value than relaxation training because passivity is a concern.
Desensitization is used in the treatment of phobias.)
A priority nursing intervention for a patient diagnosed with major depressive disorder is:
a. distracting the patient from self-absorption.
b. carefully and inconspicuously observing the patient around the clock.
c. allowing the patient to spend long periods alone in self-reflection.
d. offering opportunities for the patient to assume a leadership role in the therapeutic milieu. - correct
answer ✔B (carefully and inconspicuously observing the patient around the clock.
Approximately two thirds of people with depression contemplate suicide. Patients with depression who
exhibit feelings of worthlessness are at higher risk. Regularly planned observations of the patient with
depression may prevent a suicide attempt on the unit.)
When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will
address the negative thought patterns by using:
a. psychoanalytic therapy.
b. desensitization therapy.
c. cognitive behavioral therapy.
d. alternative and complementary therapies. - correct answer ✔C (Cognitive behavioral therapy.
Cognitive behavioral therapy attempts to alter the patients dysfunctional beliefs by focusing on positive
outcomes rather than negative attributions. The patient is also taught the connection between thoughts
and resultant feelings. Research shows that cognitive behavioral therapy involves the formation of new
connections among nerve cells in the brain and that it is at least as effective as medication. Evidence
does not support superior outcomes for the other psychotherapeutic modalities mentioned.)
A patient says to the nurse, My life does not have any happiness in it anymore. I once enjoyed holidays,
but now theyre just another day. How would the nurse document the complaint?
, a. Vegetative symptom
b. Anhedonia
c. Euphoria
d. Anergia - correct answer ✔B (Anhedonia
Anhedonia is a common finding in many types of depression and refers to feelings of a loss of pleasure
in formerly pleasurable activities. Vegetative symptoms refer to somatic changes associated with
depression. Euphoria refers to an elated mood. Anergia means without energy.)
A patient diagnosed with major depressive disorder is taking a tricyclic antidepressant. The patient says,
I dont think I can keep taking these pills. They make me so dizzy, especially when I stand up. The nurse
should:
a. explain how to manage postural hypotension, and educate the patient that side effects go away after
several weeks.
b. tell the patient that the side effects are a minor inconvenience compared with the feelings of
depression.
c. withhold the drug, force oral fluids, and notify the health care provider to examine the patient.
d. teach the patient how to use pursed-lip breathing. - correct answer ✔A (explain how to manage
postural hypotension, and educate the patient that side effects go away after several weeks.
Drowsiness, dizziness, and postural hypotension usually subside after the first few weeks of therapy with
tricyclic antidepressants. Postural hypotension can be managed by teaching the patient to stay well
hydrated and rise slowly. Knowing these facts may be enough to convince the patient to remain
medication compliant. The minor inconvenience of side effects as compared with feelings of depression
is a convincing reason to remain on the medication. Withholding the drug, forcing oral fluids, and having
the health care provider examine the patient are unnecessary steps. Independent nursing action is
appropriate. Pursed-lip breathing is irrelevant.)
A patient diagnosed with major depressive disorder is receiving imipramine (Tofranil) 200 mg every
night at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care
provider regarding potentially hazardous side effects of this drug?
